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Ansätze zur prähospitalen Gerinnungstherapie

Aktuelle Übersicht für die zivile Notfallmedizin

Approaches to pre-hospital bleeding management

Current overview on civilian emergency medicine

  • Notfallmedizin
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Zusammenfassung

Blutungen sind typische Traumafolgen. Ein Verbluten ist für rund 50 % der Todesfälle innerhalb der ersten 6 h nach Trauma verantwortlich. Zur adäquaten Blutungs- und Gerinnungstherapie zählt daher ein ineinandergreifendes Konzept, bestehend aus lokaler Blutstillung durch Druck, Kompression und ggf. Tourniquet, Wärmeerhalt, Verhinderung von Acidose und Hypokalzämie. Weiterhin wird bei geeigneten Patienten eine permissive Hypotension akzeptiert und Tranexamsäure frühzeitig eingesetzt. Zahlreiche Untersuchungen zeigen, dass die prähospitale Transfusion von Blutprodukten (z. B. Erythrozytenkonzentraten, gefrorenes Frischplasma) oder Gerinnungspräparaten (z. B. Fibrinogen) sicher und möglich, aber nur bei <5 % aller zivilen polytraumatisierten Patienten notwendig ist.

Abstract

Severe bleeding is a typical result of traumatic injuries. Hemorrhage is responsible for almost 50% of deaths within the first 6 h after trauma. Appropriate bleeding control and coagulation therapy depends on an integrated concept of local hemostasis by primary pressure with the hands, compression, and tourniquets accompanied by prevention of hypothermia, acidosis and hypocalcemia. Additionally, permissive hypotension is accepted for suitable patients and tranexamic acid should be administered early. Multiple publications prove that prehospital transfusion of blood products (e. g. red blood cells and plasma) and coagulation factors (e. g. fibrinogen) is feasible and safe, but only required for <5% of polytrauma patients in the civilian setting.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Köln, Deutschland

    H. Lier

  2. Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Bernhard

  3. Arbeitsgruppe „Trauma- und Schockraummanagement“ des Arbeitskreis Notfallmedizin, Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland

    M. Bernhard

  4. Klinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Bern, Schweiz

    J. Knapp

  5. Air Zermatt, Zermatt, Schweiz

    J. Knapp

  6. Institut für Rechtsmedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    C. Buschmann

  7. Klinik für Anästhesiologie & Intensivmedizin, Bundeswehrkrankenhaus, Ulm, Deutschland

    I. Bretschneider & B. Hossfeld

  8. Arbeitsgruppe „Taktische Medizin“ des Arbeitskreises Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland

    H. Lier & B. Hossfeld

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  1. H. Lier
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Correspondence to H. Lier.

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H. Lier, M. Bernhard, J. Knapp, C. Buschmann, I. Bretschneider und B. Hossfeld geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Lier, H., Bernhard, M., Knapp, J. et al. Ansätze zur prähospitalen Gerinnungstherapie. Anaesthesist 66, 867–878 (2017). https://doi.org/10.1007/s00101-017-0350-0

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